DOES FIBULAR FIXATION AFFECT THE TREATMENT OUTCOME OF DISTAL THIRD TIBIAL SHAFT FRACTURES?
Authors:
P. Dráč
Authors‘ workplace:
Department of Traumatology, University Hospital Olomouc
; Traumatologické oddělení FN Olomouc
Published in:
Úraz chir. 13., 2005, č.2
Overview
The purpose of this study was to evaluate the effect of fibular osteosynthesis on the outcome of distal third tibial shaft fracture treatment using unreamed tibial nail. 41 patients meeting the entry criteria were reexamined, with an average followup period of 58,6 months. Osteosynthesis of fibula had been performed on 18 of these 41 patients during primary surgery. Increased angulation was significantly smaller (p= 0,023) in the group of patients with stabilised fibula. There were also fewer delayed unions and better fun ctional outcome in comparison with patients without osteosynthesis of distal fibula. In contrast to more proximal fractures, fibular osteosynthesis is indicated in the treatment of distal third tibial shaft fractures and should be performed before intramedullary nailing of the tibia.
Key words:
distal third tibial fractures, osteosynthesis of fibula, intramedullary nailing of tibia, UTN.
Sources
1. COURTBROWN, C.M., McBIRNE, J. The epidemiology of tibial fractures. J Bone Joint Surg. 77B, 1995, 3, 417–421.
2. GOH, J.C., MECH, A.M., LEE, E.H. et al. Biomechanical study on the loadbearing characteristics of the fibula and the effects of fibular resection. Clin Orthop. 279, 1992, 223–228.
3. GOTZEN, L., HAAS, N., HUTTER, J. et al. Sinn und Unsinn der additiven Fibulaosteosynthese. Unfallheilkunde. 81, 1978, 5, 409–416.
4. GUSTILLO, R.B., MENDOZA, R.M., WILLIAMS, D.N. Problems in the management of type III (severe) open fractures: A new classification of type III open fractures. J Trauma. 24, 1984, 8, 742–746.
5. KARLSTRÖM, G., OLERUD, S. External fixation of severe open tibial fractures with the Hoffmann frame. Clin Orthop. 180, 1983, 68–77.
6. KELLAM, J. Commentary and perspective on „Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intramedullary nailing“ by Anant Kumar et al. www.eJBJS.org.
7. KRETTEK, C., KÖNEMANN, B., TSCHERNE, H. Ausnahmeindikationen für die Marknagelung. OPJournal. 11, 1995, 3, 314–323.
8. KRETTEK, C., STEPHAN, C., SCHANDELMAIER, P. et al. The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails. J Bone Joint Surg. 81B, 1999, 6, 963–968.
9. KUMAR, A., CHARLEBOIS, S.J., CAIN, E.L. et al. Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intramedullary nailing. J Bone Joint Surg. 85A, 2003, 4, 604–608.
10. LAMBERT, K.L. The weightbearing function of the fibula. A strain gauge study. J Bone Joint Surg. 53A, 1971, 4, 507–513.
11. LATTA, L.L., SARMIENTO, A., TARR, R.R. The rationale of functional bracing of fractures. Clin Orthop. 146, 1980, 28–36.
12. MORRISON, K.M., EBRAHEIM, N.A., SOUTHWORTH, S.R. et al. Plating of the fibula. Its potential value as an adjunct to external fixation of the tibia. Clin Orthop. 266, 1991, 209–213.
13. MÜLLER, C.A., STROHM, P., MORAKIS, P., PFISTER, U. Intramedullary nailing of the tibia: Current status of primary unreamed nailing. Part 1: results for closed fractures. Injury. 30, 1999, Supl 3, 37–43.
14. MÜLLER, M.E., NAZARIAN, S., KOCH, P. et al. The comprehensive classification of fractures of long bones. Berlin Heildelberg: SpringerVerlag, 1990. 201 s.
15. NICOLL, E.A. Fractures of the tibial shaft. A survey of 705 cases. J Bone Joint Surg. 46B, 1964, 3, 373–387.
16. SARMIENTO, A., GERSTEN, L.M., SOBOL, P.A. et al. Tibial shaft fractures treated with functional braces. Experience with 780 fractures. J Bone Joint Surg. 71B, 1989, 4, 602–609.
17. STEDTFELD, H.W., MITTLMEIER, T., LANDGRAF, P. et al. The logic and clinical applications of blocking screws. J Bone Joint Surg. 86A, 2004, Suppl. 2, 17–25.
18. TAKEBE, K., NAKAGAWA, A., MINAMI, H. et al. Role of the fibula in weightbearing. Clin Orthop. 184, 1984, 289292.
19. TEITZ, C.C., CARTER, D.R., FRANKEL, V.H. Problems associated with tibial fractures with intact fibula. J Bone Joint Surg. 62A, 1980, 5, 770–776.
20. TYLLIANAKIS, M., MEGAS, P., GIANNIKAS, D., et al. Interlocking intramedullary nailing in distal tibial fractures. Orthopedics, 23, 2000, 8, 805–808.
21. WEBER, T.G., HARRINGTON, R.M., HENLEY, M.B. et al. The role of fibular fixation in combined fractures of the tibia and fibula: A biomechanical investigation. J Orthop Trauma. 11, 1997, 3, 206–211.
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Surgery Traumatology Trauma surgeryArticle was published in
Trauma Surgery
2005 Issue 2
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